Archive for October 2012

The WHO Global Tuberculosis Report 2012 has recently been released. It reveals some stark figures, modest successes and large challenges. Speaking at a Media Dialogue recently from Lucknow, health activist, Ms Shobha Shukla, reading out from the report pointed out, “Only 58 lakhs (5.8 million) people were notified to national TB programmes globally and received treatment consistent with international guidelines. According to the Stop TB Partnership, this is just 66% of the estimated total number of cases and leaves around 30 lakhs (3 million) people who either received no diagnosis and treatment or got potentially substandard treatment. Sadly, this figure has not changed for the past three years.” She said further that between 1995 and 2011, 5.1 crore (51 million) people were successfully treated for TB in countries that had adopted the WHO strategy, saving 2 crore (20 million) lives. India (26%) and China (12%) together account for almost 40% of the world’s TB cases.

According to the report, India reported the largest number of 22 lakhs (2.2 million) cases of TB in 2011 which showed a decrease of 100,000 (0.1 million) cases from last year. TB mortality rate has decreased by 41% since 1990 and the TB control programme globally seems to be on track in terms of achieving the global target of a 50% reduction in TB deaths by 2015. There is now a reliable rapid diagnostic test available in 67 countries; new drugs are on the horizon as well as some promising vaccine trials. This demonstrates progress at all levels – prevention, diagnosis and treatment.

There is however, not very good news on drug-resistant forms of TB. While we are struggling to control what is an entirely preventable and curable disease, and achieving progress as the above data suggests, with alarming rapidity, prefixes such as MDR, XDR and TDR threaten to make the situation with regard to TB difficult. As Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership points out, “In 2011, there were an estimated 440 000 new cases of MDR-TB. Considering the detection and notification rate globally, we would have expected to have found around 300,000 MDR-TB cases. However, we are far away from reaching this number because we only found 56,000 people with MDR-TB and enrolled them on treatment. The difference between these figures represents a huge number of people who should have been provided with TB care. The shocking reality is that only 3.8% of new cases and 6% of previously treated cases had access to a MDR-TB diagnostic test.”

The situation raises several questions. TB, as pointed out earlier, is an entirely preventable and curable disease. If our TB control programmes were really as effective as we think they are, why would so many cases of MDR TB be amongst us?

There are several causes being cited, particularly in India, chief among them being that more than half of all TB cases are being treated by the private sector, where the quality of treatment is not as per international guidelines, and highly variable. Inadequate or lack of adherence also lead to MDR TB. Misdiagnosis, coupled with wrong or unnecessary treatment exacerbate the situation.

The situation demands that we address the proverbial last mile aggressively. The last mile in this case can be summed up as better adherence, greater involvement of the private sector and timely referrals to the national TB control programme in order to ensure correct treatment.

Dr Ditiu points out with regard to the ban on serological tests and TB being made a notifiable disease in India, “It is essential to ensure that the measures announced by the GoI and NTP will be also implemented and for this there is a need for a plan on how all these rules and regulations will be implemented at the ground level. This requires that the private sector is involved actively and the communities of affected people and civil society empowered to take action and be vocal about the achievements and challenges. The GoI is extremely interested and committed to support the TB programme and to implement recommendations made. There have been assurances that the needed funding will be provided. The challenge will be to ensure that there is flexibility in designing the budget lines. There is also a need to sustain a network of civil society and communities.”

Are we ready to traverse that last mile? JATB will attempt to find out in the coming weeks.